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Indications and practical approach to non-invasive ventilation in acute heart failure.

  • Masip J Department of Intensive Care, Consorci Sanitari Integral, University of Barcelona, Jacint Verdaguer 90, Sant Joan Despí, ES-08970 Barcelona, Spain.
  • Peacock WF Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA.
  • Price S Departments of Cardiology and Intensive Care, Royal Brompton & Harefield NHS Foundation Trust, London, UK.
  • Cullen L Department of Emergency Medicine, Royal Brisbane and Women's Hospital. Faculty of Health, Queensland University of Technology and University of Queensland, Brisbane, Australia.
  • Martin-Sanchez FJ Department of Emergency, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain.
  • Seferovic P Department of Internal Medicine, Belgrade University School of Medicine and Heart Failure Centre, Belgrade University Medical Centre, Belgrade, Serbia.
  • Maisel AS Coronary Care Unit and Heart Failure Program, Department of Cardiology, VA San Diego, USA.
  • Miro O Department of Emergency, Hospital Clínic, "Processes and Pathologies, Emergencies Research Group" IDIBAPS, University of Barcelona, Catalonia, Spain.
  • Filippatos G Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Athens University Hospital Attikon, Athens, Greece.
  • Vrints C Faculty of Medicine and Health Sciences at University of Antwerp, Antwerp, Belgium.
  • Christ M Department of Emergency Medicine, Luzerner Katonsspital, Lucerne, Switzerland.
  • Cowie M Department of Cardiology, Imperial College London (Royal Brompton Hospital & Harefield Foundation Trust), London, UK.
  • Platz E Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
  • McMurray J British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
  • DiSomma S Department of Emergency, Sant'Andrea Hospital. II Faculty of Medicine and Psychology, "LaSapienza", Rome University, Rome, Italy.
  • Zeymer U Institut für Herzinfarktforschung Ludwigshafen, Klinikum Ludwigshafen, Germany.
  • Bueno H Centro Nacional de Investigaciones Cardiovasculares, Department of Cardiology, Hospital 12 de Octubre, Madrid, Universidad Complutense de Madrid, Madrid, Spain.
  • Gale CP Department of Cardiology, York Teaching Hospital, Medical Research Council Bioinformatics Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, York, UK.
  • Lettino M Clinical Cardiology Unit, Humanitas Research Hospital, Italy.
  • Tavares M Department of Emergency, Heart Institute (InCor), University of São Paulo Medical School, Brazil.
  • Ruschitzka F Department of Cardiology, Heart Failure Clinic and Transplantation, University Heart Centre Zurich, Zurich, Switzerland.
  • Mebazaa A Department of Anesthesiology and Critical Care, U942 Inserm, APHP Hôpitaux Universitaires Saint Louis Lariboisiére, Université Paris Diderot and Hospital Lariboisiére, Paris, France.
  • Harjola VP Department of Emergency Medicine and Services, Helsinki University, Helsinki University Hospital, Helsinki, Finland.
  • Mueller C Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
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  • 2017-11-30
Published in:
  • European heart journal. - 2018
Acute cardiogenic pulmonary oedema
Acute heart failure
Bilevel pressure support
CPAP
High-flow nasal cannula
Non-invasive ventilation
Acute Disease
Heart Failure
Humans
Noninvasive Ventilation
English In acute heart failure (AHF) syndromes significant respiratory failure (RF) is essentially seen in patients with acute cardiogenic pulmonary oedema (ACPE) or cardiogenic shock (CS). Non-invasive ventilation (NIV), the application of positive intrathoracic pressure through an interface, has shown to be useful in the treatment of moderate to severe RF in several scenarios. There are two main modalities of NIV: continuous positive airway pressure (CPAP) and pressure support ventilation (NIPSV) with positive end expiratory pressure. Appropriate equipment and experience is needed for NIPSV, whereas CPAP may be administered without a ventilator, not requiring special training. Both modalities have shown to be effective in ACPE, by a reduction of respiratory distress and the endotracheal intubation rate compared to conventional oxygen therapy, but the impact on mortality is less conclusive. Non-invasive ventilation is also indicated in patients with AHF associated to pulmonary disease and may be considered, after haemodynamic stabilization, in some patients with CS. There are no differences in the outcomes in the studies comparing both techniques, but CPAP is a simpler technique that may be preferred in low-equipped areas like the pre-hospital setting, while NIPSV may be preferable in patients with significant hypercapnia. The new modality 'high-flow nasal cannula' seems promising in cases of AHF with less severe RF. The correct selection of patients and interfaces, early application of the technique, the achievement of a good synchrony between patients and the ventilator avoiding excessive leakage, close monitoring, proactive management, and in some cases mild sedation, may warrant the success of the technique.
Language
  • English
Open access status
bronze
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Persistent URL
https://sonar.ch/global/documents/93940
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